NARCH9 Asthma Project - ?Enhancing Control of Childhood Asthma in AI/AN Communities?. Pediatric asthma poses a particularly heavy public health burden in Indian County where the prevalence of asthma in American Indian and Alaska Native (AI/AN) children is estimated at 15.1%, as compared to the general US population of 9.5%. The consequences of this condition are major and affect not only patients but their families in the forms of interference with daily activities, missed days of school and work, and worry and concern. This project is important because it seeks to enhance and disseminate a promising intervention to improve asthma control and reduce asthma- related health care utilization in America Indian communities in the Pacific Northwest. It is also important because it aligns with Healthy People 2020 goals and the priorities of the Indian Health Service. It is innovative because it approaches control of childhood asthma from the unique perspective of integrating the currently separate medical care system and the system of environmental health services to improve the quality of asthma care delivery to children and teens. Previous studies of pharmacist-delivered asthma health education and in-home reduction of asthma triggers have consistently demonstrated increases in asthma-free days and quality of life, and reductions in urgent care and emergency department services. However, the effectiveness of this integrated approach has not yet been demonstrated in AI/AN communities served by I.H.S. clinics. We will conduct a prospective characterization of the effectiveness of a pharmacy- managed asthma clinic linked with home visits by environmental health specialists to reduce in-home asthma triggers. In the clinic, patients and their parent caregiver will receive in-depth asthma education from pharmacists, that will include demonstration and practice in the use of peak flow meters and medication devices. Subsequently, home visits by trained environmental health specialists will evaluate the presence of common triggers (smoking, house dust mite, pets, pests, and mold) and households will be provided low-emission vacuum cleaners, mattress covers, and green cleaning supplies. Over the following 12-month period, we will measure patient and parent/caregiver self-efficacy, symptom reduction, medication adherence, quality of life, and urgent care and emergency department visits. Ultimately, asthma control programs will be implemented in four tribal communities in the Pacific Northwest. The resulting protocols and lessons learned will be used to publish a set of recommended protocols and training materials for wider dissemination.